On resection of the Gasserian ganglion / W.W. Keen and W.G. Spiller ; with a pathological report on seven ganglia removed by Professor Keen.

  • William Williams Keen
Date:
[1898]
Catalogue details

Licence: Public Domain Mark

Credit: On resection of the Gasserian ganglion / W.W. Keen and W.G. Spiller ; with a pathological report on seven ganglia removed by Professor Keen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    16/44 page 14
    IT. To what extent shall the ganglion he removed? Tiffany has expressed the opinion(1 )that the motor root can be saved, and (2) that it ought to be saved. In a number of my cases, though I have made no attempt to save the motor root, the muscles of mastication, on the operated side, were not wholly paralysed. In Case VI, in which the motor root was certainly removed, the muscles of mastication, on the operated side, are atrophied and useless, but the patient can readily masticate meats, the lower jaw being easily moved by the muscles of the opposite side. I do not, however, myself believe that the motor root can be preserved. In the first place, I do not think that, from an operative point of wiew, it is possible to do so, and, secondly, the very careful dissection of the gang!ion made by Jouvara {C-hipa all's Tra- vaux de Neurologic chirurgicale Vol. II, 1807, p. 205) makes me sure that this is even anatomically quite impossible. He says (pp. 209-10) « the masticatory nerve [by which I take it he means the motor root] and its branches are very adhe- rent to the trunk of the inferior maxillary division, and arc contained in the same sheath of connective tissue: the separation of these two nerves is difficult even by the most ca- reful dissection, and to avulse the inferior maxillary without, at the same time, avulsing the masticatory nerve is ve- ritably impossible ». Tiffany, however, is speaking of cutting the masticatory nerve before it becomes apart of the infe- rior maxillary. If this cannot be done on the dead body by the most careful dissection, how much less can it be done on the living during the exigencies of an operation. In the microscopical examination of my case (Case VI) the motor root was found to form an intimate part of the third branch so near the ganglion that it would have been very difficult, or even impossible, to separate it from the ganglion at the time of operation. Another point is wor- thy of mentioning; the peripheral sensory branches must degenerate after resection of the ganglion, and it may be
    digitised image 1
    digitised image 2
    digitised image 3